The present disclosure relates to an electrode catheter. Particularly, the present disclosure relates to an electrode catheter for measuring an electric potential inside a heart of a patent.
JP-A-2002-191571 discloses an electrode catheter for measuring an electric potential inside a heart of a patient. According to the electrode catheter disclosed in JP-A-2002-191571, a plurality of ring electrodes are arranged side by side and provided on a distal end portion of a tube body, and a variation of the electric potential inside the heart can be measured by any of the plurality of ring electrodes (contact electrodes). While moving the electrode catheter, a medical worker carefully observes the variation of the electric potential inside the heart acquired from the electrode catheter. In this manner, the medical worker can estimate a place where arrhythmia (e.g. atrial fibrillation etc.) occurred inside the heart (e.g. inside a left atrium).
Each of the ring electrodes has to be in contact with an endocardium of the heart as a precondition for measuring the variation of the electric potential inside the heart using the electrode catheter. This is because an electric signal acquired from a predetermined ring electrode cannot reflect the variation of the electric potential inside the heart when the predetermined ring electrode is not in contact with the endocardium. Therefore, before observing the variation of the electric potential inside the heart (e.g. an electrocardiogram waveform) that is acquired from each of the ring electrodes and displayed on a monitor, the medical worker has to confirm whether the ring electrode is in contact with the endocardium or not. On the other hand, it is difficult for the medical worker to accurately determine whether the predetermined ring electrode is in contact with the endocardium or not by use of an X-ray fluoroscopic image of the patient.
To solve this problem, a method about how to determine contact between a predetermined ring electrode and the endocardium based on a variation of an impedance value between the ring electrode and an electrode attached to the patient has been under review. In this respect, since electric conductivity of blood is larger than electric conductivity of the endocardium, an impedance value measured by the ring electrode which has already been in contact with the endocardium is larger than an impedance value measured by the ring electrode which has not been in contact with the endocardium yet. It is however difficult to accurately determine the contact between the ring electrode and the endocardium when there is a small variation between the impedance value measured by the ring electrode which has already been in contact with the endocardium and the impedance value measured by the ring electrode which has not been in contact with the endocardium yet. From this viewpoint, there is still room for further improvement of usability of the electrode catheter.
The present disclosure provides an electrode catheter whose usability is improved.
According to one or more aspects of the present disclosure, there is provided an electrode catheter for measuring an electric potential inside a heart of a subject.
The electrode catheter comprises:
The non-contact electrode is provided on the outer circumferential surface of the distal end portion or the guide portion so as not to make contact with the endocardium in a state where the contact electrode is in contact with the endocardium.
An embodiment of the present invention (hereinafter referred to as present embodiment) will be described below with reference to the drawings. Incidentally, description about members having the same reference signs as those of members that have already been described in description of the present embodiment will be omitted for convenience of explanation. In addition, in some cases, dimensions of each member shown in the drawings may be different from actual dimensions of the member for convenience of explanation.
The shaft 2 is configured to be inserted into the heart. The shaft 2 is configured, for example, by a hollow flexible tube, and has a distal end portion 7 and a guide portion 8. The shaft 2 is formed, for example, out of a resin material. The distal end portion 7 is configured to make contact with an endocardium of the subject. Particularly, the distal end portion 7 is formed into a planar shape (e.g. a ring shape) in order to configure a contact surface for making contact with the endocardium (see
The handle 3 can be operated by the medical worker. The medical worker who operates a predetermined operating portion (not shown) provided in the handle 3 can control the guide portion 8 of the shaft 2 to bend. Particularly, the guide portion 8 has a bendable portion 20 (see
Next, a specific configuration of the distal end portion 7 of the shaft 2 will be described with reference to
As shown in
In addition, as shown in
In addition, an operating wire (not shown) configured to bend the guide portion 8 of the shaft 2 may be provided in the hollow portion 13. When the operating wire bends in accordance with an operation performed on the handle 3 (see
Next, a method for comparing an impedance value between each of the ring electrodes 6 and an impedance measuring electrode attached to a part (e.g. the back etc.) of a body of the subject, with an impedance value between the non-contact electrode 5 and the impedance measuring electrode to thereby determine contact between the ring electrode 6 and the endocardium will be described with reference to
Incidentally, the impedance measuring electrode may be attached to the body surface of the back etc. of the subject, or may be placed inside the body of the subject. In this respect, one of the ring electrodes 6 may function as the impedance measuring electrode. In addition, the impedance measuring electrode may be connected to the ground. In addition, the impedance value indicates the amplitude of impedance. The impedance value relevant to the ring electrode 6 may be measured based on a value of an AC voltage of a predetermined frequency applied to the ring electrode 6 and a current value outputted from the ring electrode 6. In addition, the impedance value relevant to the non-contact electrode 5 may be measured based on the value of the AC voltage of the predetermined frequency applied to the non-contact electrode 5 and a current value outputted from the non-contact electrode 5. Further, assume that each of the ring electrodes 6 and the non-contact electrode 5 are formed out of the same material, and the surface area of the non-contact electrode 5 is substantially equal to the surface area of the ring electrode 6.
First, description will be made about a state in which each of the ring electrodes 6 is not in contact with the endocardium. In this state, the surface of the ring electrode 6 makes contact with only blood. Therefore, an impedance value between the ring electrode 6 and the impedance measuring electrode is mainly determined based on electric conductivity α1 of the blood. On the other hand, the surface of the non-contact electrode 5 also makes contact with only the blood. Therefore, an impedance value between the non-contact electrode 5 and the impedance measuring electrode is also mainly determined based on the electric conductivity α1 of the blood. Thus, in the state in which each of the ring electrodes 6 is not in contact with the endocardium, the impedance value between the ring electrode 6 and the impedance measuring electrode is substantially equal to the impedance value between the non-contact electrode 5 and the impedance measuring electrode, or a difference between the two impedance values is small.
Next, in a state in which each of the ring electrodes 6 is in contact with the endocardium, as shown in
According to the present embodiment, the non-contact electrode 5 does not make contact with the endocardium even in the state in which each of the ring electrodes 6 is in contact with the endocardium (the state shown in
Accordingly, by referring to the impedance value relevant to the non-contact electrode 5, it is possible to accurately determine whether the ring electrode 6 is in contact with the endocardium or not. Accordingly, it is possible to accurately measure a variation of an electric potential inside the heart (e.g. inside the left atrium) of the subject. Thus, it is possible to provide the electrode catheter 1 whose usability is improved.
Particularly, in the present embodiment, it is possible to accurately determine whether the ring electrode 6 is in contact with the endocardium or not, without moving the distal end portion 7 of the shaft 2 but with the distal end portion 7 kept in a still state as it is.
Incidentally, determination about the contact between the ring electrode 6 and the endocardium based on the comparison between the impedance value relevant to the ring electrode 6 and the impedance value relevant to the non-contact electrode 5 may be automatically made by a computer (a processor such as a CPU) communicably connected to the electrode catheter 1. In this case, the computer may acquire the impedance value relevant to the ring electrode 6 and the impedance value relevant to the non-contact electrode 5 from the electrode catheter 1, and then automatically determine the contact between the ring electrode 6 and the endocardium based on the acquired impedance values and a contact determination program. Alternatively, the contact determination may be subjectively made by the medical worker operating the electrode catheter 1. In this case, the medical worker may visually recognize the impedance value relevant to the ring electrode 6 and the impedance value relevant to the non-contact electrode 5 displayed on the display device (not shown) to thereby subjectively determine the contact between the ring electrode 6 and the endocardium.
In addition, according to the present embodiment, the ring electrodes 6 can make contact with the endocardium simultaneously. Accordingly, it is possible to simultaneously measure variations of intracardiac electric potentials corresponding to the ring electrodes 6 respectively. Further, since the extension direction of the distal end portion 7 of the shaft 2 and the extension direction of the guide portion 8 of the shaft 2 are different from each other, it is possible to increase a contact area between the distal end portion 7 and the endocardium. Accordingly, it is possible to increase the number of the ring electrodes 6 capable of making contact with the endocardium simultaneously. Further, in a state in which the ring electrodes 6 provided on the outer circumferential surface 7S of the distal end portion 7 are in contact with the endocardium, the non-contact electrode 5 provided on the outer circumferential surface 8S of the guide portion 8 can be surely prevented from making contact with the endocardium.
In addition, according to the present embodiment, each of the ring electrodes 6 and the non-contact electrode 5 are formed out of the same material, and the surface area of the non-contact electrode 5 is substantially equal to the surface area of the ring electrode 6. Therefore, in the state in which the ring electrode 6 is not in contact with the endocardium, the impedance value relevant to the ring electrode 6 and the impedance value relevant to the non-contact electrode 5 are substantially equal to each other. Therefore, when the difference between the two impedance values is small (particularly close to zero), it is possible to determine that the ring electrode 6 is not in contact with the endocardium. On the other hand, when the difference between the two impedance values is large, it is possible to determine that the ring electrode 6 is in contact with the endocardium. Incidentally, the non-contact electrode 5 may be formed out of an electrically conductive material different from that of the ring electrode 6 or the surface area of the non-contact electrode 5 may be different from the surface area of the ring electrode 6. In this respect, for example, assume that, the impedance value relevant to the ring electrode 6 is Z1 and the impedance value relevant to the non-contact electrode 5 is Z2 (Z1≠Z2) in the state in which the ring electrode 6 is not in contact with the endocardium. In this case, when a difference ΔZ between the impedance value relevant to the ring electrode 6 and the impedance value relevant to the non-contact electrode 5 is a value close to (Z2−Z1), it is possible to determine that the ring electrode 6 is not in contact with the endocardium. On the other hand, when the difference ΔZ between the impedance value relevant to the ring electrode 6 and the impedance value relevant to the non-contact electrode 5 is a value far from (Z2−Z1), it is possible to determine that the ring electrode 6 is in contact with the endocardium.
Next, a placement position of the non-contact electrode 5 will be described with reference to
(Modification)
Next, an electrode catheter 1A according to a modification of the present embodiment will be described below with reference to
The electrode catheter 1A according to the present modification differs from the electrode catheter 1 according to the present embodiment at the point that a plurality of chip electrodes 6A (an example of contact electrodes) are provided in place of the plurality of ring electrodes 6. As shown in
In addition, the respective chip electrodes 6A make contact with the endocardium of a heart simultaneously in the state in which the distal end portion 7 is in contact with the endocardium. In other words, the chip electrodes 6A are positioned on the outer circumferential surface 7S of the distal end portion 7 making contact with the endocardium. Each of the chip electrodes 6A is electrically connected to a corresponding one of electric wires 12 through a connection conductor 16. The electric wires 12 are provided in a hollow portion 13 of the shaft 2.
In addition, as shown in
According to the present modification, the non-contact electrode 5A does not make contact with the endocardium in the state in which each of the chip electrodes 6A is in contact with the endocardium (the state shown in
Accordingly, by referring to the impedance value relevant to the non-contact electrode 5A, it is possible to accurately determine whether the chip electrode 6A is in contact with the endocardium or not. Accordingly, it is possible to accurately measure a variation of an electric potential inside the heart (e.g. inside a left atrium) of the subject. Thus, it is possible to provide the electrode catheter 1A whose usability is improved. Particularly, in the present modification, it is possible to accurately determine whether the chip electrode 6A is in contact with the endocardium or not, without moving the distal end portion 7 of the shaft 2 but with the distal end portion 7 kept in a still state as it is.
Although the embodiment of the present invention has been described above, the technical scope of the present invention should not be interpreted limitedly based on the description of the present embodiment. The present embodiment is merely exemplified. It should be understood by those skilled in the art that various changes can be made on the embodiment within the scopes of the claimed inventions. The technical scopes of the claimed inventions should be defined based on the scope of the claims and its equivalent scope.
For example, in the present embodiment, the distal end portion 7 of the shaft 2 is formed into a ring shape to have the contact surface for making contact with the endocardium. However, the shape of the distal end portion 7 is not limited thereto. For example, the distal end portion 7 may be formed into a radial shape, a hexagonal shape or a spiral shape.
This application is based on Japanese Patent Application No. 2017-215638 filed on Nov. 8, 2017, the entire contents of which are incorporated herein by reference.
Number | Date | Country | Kind |
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2017-215638 | Nov 2017 | JP | national |
Filing Document | Filing Date | Country | Kind |
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PCT/JP2018/040639 | 11/1/2018 | WO |
Publishing Document | Publishing Date | Country | Kind |
---|---|---|---|
WO2019/093213 | 5/16/2019 | WO | A |
Number | Name | Date | Kind |
---|---|---|---|
4955382 | Franz | Sep 1990 | A |
5398683 | Edwards | Mar 1995 | A |
5423878 | Franz | Jun 1995 | A |
5445148 | Jaraczewski | Aug 1995 | A |
5476495 | Kordis | Dec 1995 | A |
5562619 | Mirarchi | Oct 1996 | A |
5823955 | Kuck | Oct 1998 | A |
6001085 | Lurie | Dec 1999 | A |
6241724 | Fleischman | Jun 2001 | B1 |
6301496 | Reisfeld | Oct 2001 | B1 |
6892091 | Ben-Haim | May 2005 | B1 |
8452422 | Desinger | May 2013 | B2 |
9636164 | Panescu | May 2017 | B2 |
9993178 | Panescu | Jun 2018 | B2 |
10973436 | Kusumoto | Apr 2021 | B2 |
11020180 | Viswanathan | Jun 2021 | B2 |
11259869 | Mickelsen | Mar 2022 | B2 |
11350815 | Rothe | Jun 2022 | B2 |
20070191709 | Swanson | Aug 2007 | A1 |
20120130368 | Jenson | May 2012 | A1 |
20140364715 | Hauck | Dec 2014 | A1 |
20170274177 | Helgeson | Sep 2017 | A1 |
20190374120 | Hauck | Dec 2019 | A1 |
20200275855 | Soma | Sep 2020 | A1 |
Number | Date | Country |
---|---|---|
2001-292973 | Oct 2001 | JP |
2002-191571 | Jul 2002 | JP |
2016-524480 | Aug 2016 | JP |
Entry |
---|
Japanese Office Action dated Jun. 8, 2021 issued in Patent Application No. 2017-215638. |
International Search Report Issued in Patent Application No. PCT/JP2018/040639 dated Jan. 23, 2019. |
Written Opinion Issued in Patent Application No. PCT/JP2018/040639 dated Jan. 23, 2019. |
Number | Date | Country | |
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20200275855 A1 | Sep 2020 | US |